Provider Demographics
NPI:1023587409
Name:EARTHLY VESSELS SENIOR CARE
Entity type:Organization
Organization Name:EARTHLY VESSELS SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:214-865-6165
Mailing Address - Street 1:17304 PRESTON RD STE 800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5645
Mailing Address - Country:US
Mailing Address - Phone:214-865-6165
Mailing Address - Fax:972-972-8343
Practice Address - Street 1:17304 PRESTON RD STE 800
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5645
Practice Address - Country:US
Practice Address - Phone:214-865-6165
Practice Address - Fax:972-972-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health